Get the answers to all of your questions on the new RAP rules when two of the foremost experts in home health, Nick Seabrook and Todd Montigney, examine the key elements of the new RAP billing rules, answering specific scenario questions and providing operational insights and strategies to best prepare your agency for 2021.

As CMS and EMR guidance and clarification continues to emerge, this webinar is designed to inform agencies of the most up to date information regarding the new RAP rules and provide insight for how to avoid process breakdowns that could make your agency subject to costly penalties. We’ll provide guidance toward developing the right plan and structure to ensure accurate billing and meet filing expectations. This webinar will also provide insight into the cash flow implications of the RAP payments reducing from 20% of HHRG value to 0%.

Key Takeaways

  • Raps will need to be on file within 5 calendar days (including weekends).
    • Payment penalty is equal to 1/30th reduction of the HIPPS code
  • HIPPS code on the RAP must match the HIPPS code on final claim, but the primary diagnosis code on RAP does not have to match primary diagnosis code on final.
  • Patients that are transitioning over from prior year will need a RAP for every single payment period.
  • The OASIS does not need to be completed and locked in order to submit the RAP.
  • You do not need to bill a first billable visit in order to bill a second RAP.
  • Make sure that you are checking eligibility frequently to see if Medicare is showing up as the primary or secondary payor, especially at the change of the new year.
  • You shouldn’t be concerned about the generic HIPPS code because Medicare is not basing payments on the HIPPS.

BlackTree Recommends

  • Bill all RAPS and final claim with the same generic HIPPS code, keep in mind the RAP does have to match the final claim.
  • Key RAPS into DDE if the EMR does not support timely submission of RAPS
  • Make sure you are using any kind of valid diagnosis code if you do not have an acceptable diagnosis code.
  • Recommend that you are billing RAPS out daily.
    • Consider doing two batches on Mondays and Fridays if you do not have a weekend biller (early morning and late afternoon)
  • Do screenshots of RAPS that kickback to RTP. The screenshot will serve as proof that the RAP was submitted timely.
  • Determine if your Medicare Advantage plans are adopting the 5-day timely filing rule
    • Medicare advantage claims should be billed with the actual HIPPS code
    • Prioritize patients to ensure OASIS is completed before the 5-day timely filing.
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